Health Promotion in Schools of Music

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Initial Recommendations for Schools of Music

Kris S. Chesky, Ph.D.; William J. Dawson, M.D.; and Ralph Manchester, M.D., for the Health Promotion in Schools of Music Project


The primary goal of the Health Promotion in Schools of Music (HPSM) Project is to assist schools of music to prevent occupational injuries associated with learning and performing music. With this goal in mind, a national conference was hosted in the fall of 2004 to connect health care experts with individuals and organizations involved in the education of musicians.


HPSM recognizes fundamental challenges in responding to the health risks associated with learning and performing music. In addition to current research showing that young musicians enter college with existing problems, the underlying physiological and psychological mechanisms for performance
injuries are multidimensional and involve both individual and music-related variables as well as a myriad of social, environmental, and cultural factors. Because of this complexity, HPSM recommends Prevention Education and Intervention as the primary approach for schools of music to address these problems. HPSM recognizes the need for a common and unifying framework that consolidates an academic agenda that focuses on individual knowledge, responsibility, and action with a coherent and integrated continuum of experiences for students.

In order to be effective, Prevention Education must go beyond simply “delivering” instruction or “disseminating” information and must address issues that affect music students’ values, beliefs, and motivations.

Recommendations for a Health Promoting framework were corroborated by the Board of Directors of the Performing Arts Medicine Association in the fall of 2005 and then presented to and reviewed by the Executive Committee of the National Association of Schools of Music in fall of 2005 and
again in the spring of 2006.

The following HPSM consensus-based declarations and recommendations provide the basis for action. The materials are designed for consideration by schools of music administrators and faculty as suggestions for creating better environments and improved educational practices with regard to
professional health of music students and the prevention of performance injuries.


  • Performance injuries are preventable. A holistic approach that encourages wellness and personal responsibility is necessary for prevention. Schools of music should focus on Prevention Education in addition to supporting efforts directed at treating diseases once they have occurred.
  • Schools of music do influence student behaviors through factors such as collective values, beliefs, and actions. These factors need to be considered and modified as crucial first steps toward reducing the rate and severity of performance injuries. A health promotion framework offers a common philosophical and practical basis for such efforts and would allow for effective and sustainable prevention-oriented educational efforts.
  • Without diminishing the concerns for musculoskeletal, vocal, and mental health, schools of music should recognize that Noise-Induced Hearing Loss is a widespread and serious public health issue and that music is always implicated as a causal factor. This problem receives little or no recognition in schools of music. A high priority strategy is needed for informing all music students about the risks for noise-induced hearing loss.
  • Because many of the physical, psychological, and sociological determinants for performance injuries are well established before young musicians attend college, schools of music must prepare health-conscious music educators and produce injury-free musicians. Music education faculty must acknowledge the possible negative consequences of learning and performing music and prepare future teachers accordingly.


  1. Adopt a Health Promotion Framework

    The World Health Organization (WHO) was established in 1948 and defines health as a complete state of physical, mental, and social well-being, not just the absence of disease. The health promotion orientation grew out of the discoveries that show many factors such as social norms, cultural values and beliefs, perceived stress, quality of support, and environments play essential roles in the quality of a person’s health.Health promotion as an organized field can be traced to 1974 when the Canadian government identified health promotion as a key strategy aimed at informing, influencing, and assisting both individuals and organizations so that they will accept more responsibility and be more active in matters affecting mental and physical health. In 1986, the WHO held the first International Conference on Health Promotion, where the Ottawa Charter for Health Promotion action plan was created. The focus of this plan was to promote the creation of health-centered settings that enable people to have increased control over their health and its improvement.

    With the overall aims of embedding within an organization an understanding and commitment to holistic health and the motivation to develop its health-promoting potential, the settings-based approach to health promotion has led to several international movements, including Health Promoting Cities, Hospitals, Schools, and Universities.

    Why Health-Promoting Schools of Music?—Faculty within schools of music, particularly those with expertise in music performance, music education, pedagogy, and conducting, represent the primary channels for changing how music is taught and played in order to reduce performance injuries.Music faculty, more than any other group, embody the critical determinants for establishing social and cultural values and beliefs that are so important for influencing students. Music school faculty need to become substantially involved in the prevention of injuries. Interdisciplinary and collaborative strategies with groups and individuals outside of music need to be initiated. However, reliance on these outside professionals without the essential involvement of music faculty will ultimately fail.

  2. Develop and Offer an Undergraduate “Occupational Health” Course for All Music Majors The primary role for all schools of music is education. Prevention education is the foundation for injury prevention. At a minimum, schools of music should offer at least one introductory- level undergraduate course that covers the occupational health concerns related to music.
  3. Educate Students about Hearing Loss as Part of Ensemble-Based Instruction Using scientifically derived protocols developed by the National Institutes of Occupational Safety and Health (NIOSH) and endorsed by the American Academy of Audiology (AAA), National Hearing Conservation Association (NHCA), and National Institute of Deafness and Communicative Diseases (NIDCD), experts agree that music students are at risk for hearing loss and that they should be routinely informed and educated as part of ensemble-based instruction.Research suggests that 30 to 50% of musicians report problems with hearing loss. For the musician, hearing loss can lead to very serious personal and professional consequences, including potential career-ending outcomes because of the potential perception problems and permanent tinnitus. Daily sound exposures for most music students are composed of two or more periods of ensemble participation, together with other sound-producing activities, such as personal practice time, studio lessons, section rehearsals, academic and professional performances, and other academic and leisure listening activities. The combined effects of such exposures must be considered in establishing and minimizing risk, rather than focusing on the effects of individual events.
  4. Assist Students through Active Engagement with Health Care Resources.Music students need to know when and where to go for help. Directors of student health resources, including student health centers, speech and hearing centers, mental health counseling centers, and others, need to know that music students may have unique and challenging health situations and that there are resources and performing arts medicine
    experts willing to help if needed.


As first fruits of this project, HPSM offers a general strategic framework for schools of music to become settings for health promotion. HPSM also offers recommendations for
practice and priority initiatives, including the urgent need to address the risk for hearing loss among music students and for music educators to prepare future teachers in prevention education.

HPSM recognizes that each school of music is unique and understands that there is a need for quality teaching materials designed to support these recommendations. The goals of HPSM include the ongoing development of models for implementation along with support materials for use in various
educational contexts. In partnership with the Performing Arts Medicine Association, HPSM will use the Internet to house and disseminate various resources, including short papers on health
issues for music students, DVD or video information, or other sets of instructional materials.
Additional information will be published in the Medical Problems of Performing Artists journal. An ongoing priority is to encourage and support research focusing on both the needs of music students and the consequences of various educational interventions.


The Health Promotion in Schools of Music (HPSM) project would not have materialized without support from the University of North Texas

System and the Performing Arts Medicine Association.

The HPSM project has involved many dedicated professionals from both performing arts medicine and music. These professionals have made significant contributions and should be recognized as pioneers in our collective efforts to establish health-promoting schools of music.

This project represents a unique set of partnerships that includes over 20 national and international organizations. These relationships are vital to this process and serve as an outstanding model for interdisciplinary collaboration on behalf of all musicians and music students.

Support for Health Promotion in School of Music is provided by:
National Endowment for the Arts, Grammy Foundation, International
Foundation for Music Research, International Association for Music Merchants
(NAMM), and Scott Foundation.

The Health Promotion in Schools of Music (HPSM) Project is a collaborative effort between the University of North Texas System and the Performing Arts Medical Association and includes professionals from both performing arts medicine and music. HPSM represents a unique set of partnerships of over 20 professional organizations.

Lists of participating individuals and organizations are posted on the HPSM website ( The website also contains background information, including videos of all HPSM conference sessions, along with summaries by various working groups.
Dr. Chesky is Cofounder and Director of Education and Research, Texas Center for Music and Medicine, University of North Texas, Denton, Texas; Dr. Dawson is current President of the Performing Arts Medicine Association and is at the Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and Dr. Manchester is Editor of Medical Problems of Performing Artists and Director of the University Health Service, University of Rochester School of Medicine and Dentistry, Rochester, New York.

The ideas expressed in this document, and many others, were discussed and written about before, during, and following the HPSM conference in September/October 2004. This presentation is a continuation of these activities and does not represent a summary. The following recommendations
were corroborated by the Board of Directors of the Performing Arts Medicine Association in the fall of 2005 and then presented to and reviewed by the Executive Committee of the National Association of Schools of Music in fall of 2005 and again in the spring of 2006.

Address correspondence to: Dr. Kris Chesky at

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